3D打印模板辅助标准化施源器在ⅢB期宫颈癌影像引导自适应近距离治疗中的应用

doi:10.3760/cma.j.cn113030-20200511-00246

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摘要目的探讨3D打印模板辅助标准化施源器在宫颈癌影像引导自适应近距离治疗(BT)中的应用。方法对 23例外照射(45Gy分25次)后宫旁受侵袭范围较大的 ⅢB期宫颈癌患者行MRI引导自适应BT,处方剂量为7 Gy/次,共4次。根据外照射前后MRI中肿瘤消退情况确定BT范围,预估应用标准化腔内联合组织间插植(IC+IS)施源器剂量欠量区域。对欠量区域虚拟经会阴组织间插植针道,并优化植入角度、间距、深度等。应用图形设计软件设计辅助插植模板,并使用3D打印技术打印辅助模板,并与标准化施源器结合紧密。在全麻条件下超声引导完成IC+IS,术后对患者行MRI定位扫描。将定位MRI传入治疗计划系统进行靶区和危及器官勾画,并给予IC+IS治疗计划设计优化,最终完成计划评估及治疗。结果 3D打印个体化插植模板平均打印时间为(3.5±1.0) h,辅助模板共引导植入插植针382根,单分次(4.2±1.5)根,剂量权重比为(16.49±9.50)%。靶区EQD2Gy,α/β=10剂量高危靶区D90%为(90.45±3.03) Gy,中危靶区D90%为(66.46±3.68) Gy。膀胱、直肠、小肠、乙状结肠的 D2cm³EQD2Gy,α/β=3分别为(82.69±2.60)、(73.20±2.52)、(69.35±3.32)、(69.39±3.27) Gy,均满足临床剂量要求。1年和 2年局部控制率、无远处转移生存率、总生存率分别为96%和87%、87%和70%、96%和78%。结论利用3D打印技术制作的辅助插植施源器可以有效弥补现有标准化施源器在 ⅢB期宫颈癌临床BT时大体积靶区剂量的不足,为晚期宫颈癌BT提供了较为有效的方法。

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	赵志鹏
	管薇
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	程光惠

关键词 ：宫颈肿瘤/近距离疗法, 标准化施源器, 辅助模板, 3D打印

Abstract：Objective To explore the application of 3D printing technology-assisted standardized applicator in the image-guided adaptive brachytherapy (IGABT) for cervical cancer. Methods Twenty-three patients with stage ⅢB cervical cancer with extensive paracervical invasion after external irradiation (45Gy/25f) were treated with IGABT, and the prescription dose was 7Gy/f×4f. According to the regression of tumor on MRI before and after external irradiation, the range of brachytherapy was determined, and the under dose area of standard intracavitary/interstitial applicator (IC+IS) was estimated. The virtual transperineal needle channel was inserted in the under dose area, the angle, spacing and depth of implantation were optimized. The auxiliary templates were designed with graphic design software, and 3D printing technology was utilized to print the auxiliary templates. The auxiliary templates were closely combined with the standardized applicator. Under the anesthesia condition, ultrasound-guided applicator was completed, and patients were scanned with MRI image after operation. The MRI images were introduced into treatment planning system (TPS) to delineate the target area and organs at risk, and the treatment plans were optimized to complete the plan evaluation and treatment. Results The average printing time of templates was (3.5±1.0) h, 382 implant needles were inserted guided by auxiliary templates,(4.2±1.5) template-guided implant needles were used in each fraction and the weight ratio was (16.49±9.50)%. The total dose of HR-CTV D90% EQD2Gy,α/β=10 was (90.45±3.03) Gy, and IR-CTV D90% EQD2Gy,α/β=10 was (66.46±3.68) Gy. The D2cm³EQD2Gy,α/β=3of the bladder, rectum, small intestine and sigmoid colon were (82.69±2.60) Gy,(73.20±2.52) Gy,(69.35±3.32) Gy and (69.39±3.27) Gy, respectively, all of which met the clinical dose requirements. The 1-and 2-year local control rates were 96% and 87%, 87% and 70% for the distant metastasis-free survival rates, and 96% and 78% for thea overall survival rates, respectively. Conclusion The auxiliary applicators made by 3D printing technology can effectively compensate for the dose insufficiency of the standard applicator in the paracervical and other areas during the clinical brachytherapy in patients with stage ⅢB cervical cancer, providing an effective method for the brachytherapy of advanced cervical cancer.

Key words： Cervical neoplasm/brachytherapy Standardized applicator Auxiliary template 3D print

收稿日期: 2020-05-11

基金资助:国家自然科学基金(81703034);吉林省科技厅自然基金(白求恩专项)(20160101079JC);吉林省科技厅社发处项目(20190303151SF)

通讯作者: 程光惠,Email:chenggh@jlu.edu.cn

引用本文:

赵志鹏,管薇,赵红福等. 3D打印模板辅助标准化施源器在ⅢB期宫颈癌影像引导自适应近距离治疗中的应用[J]. 中华放射肿瘤学杂志, 2020, 29(8): 661-665.

Zhao Zhipeng,Guan Wei,Zhao Hongfu et al. Application of 3D printing technology-assisted standardized applicator in image-guided adaptive brachytherapy of stage ⅢB cervical cancer[J]. Chinese Journal of Radiation Oncology, 2020, 29(8): 661-665.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.cn113030-20200511-00246 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2020/V29/I8/661

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